Governor Andrew Cuomo’s office is facing a political firestorm after admitting that the full toll of COVID-19 fatalities among New York's nursing home residents was kept secret for nearly a year. Though Cuomo now concedes his delay in releasing the data created “a void” within which speculation thrived and families suffered, it’s still unclear if his requirement that nursing homes accept recovering COVID-19 patients from hospitals directly worsened outcomes inside the facilities.

Public health experts say that’s because the Cuomo administration still hasn’t been fully transparent about the sequence of events that transpired within nursing homes. With the currently available data, they say it’s impossible to definitively determine the aftereffects of a controversial March 25 executive order that required nursing homes to admit COVID-19-positive patients leaving hospitals. The Associated Press reported last week that more than 9,000 recovering COVID-19 patients were transferred under this policy—40% more than what was previously released by officials.

“There’s very mixed evidence on the impact of patient transfers,” said Priya Chidambaram, a senior policy analyst at Kaiser Family Foundation, who looked at a New York State Health Department report on the issue as well as studies of hospital transfers to nursing homes in Maryland and Michigan. Because New York didn’t report the number of COVID-19 cases per facility during the early days of the pandemic, it’s unknown if outbreaks at the homes grew in size following patient transfers.

“That’s still something we haven’t been able to answer,” she said.

As COVID-19 spread inside nursing homes last spring, pre-existing issues with staffing levels and infection control compounded the devastation. Attorney General Letitia James reported last month that a lack of protective gear and testing worsened the virus’s spread. At the same time, families were often kept in the dark about what was going on inside these care facilities.

Stephen Hanse, the President of the New York State Health Facilities Association, a trade group representing nursing home operators across the state, said nursing homes were “by and large left to their own devices” while the state was prioritizing resources to hospitals.

Until late January, New York was the only state in the country not publicly counting the deaths of nursing home residents in hospitals among their tallies for long-term care facilities, according to the Kaiser Family Foundation that looked at nursing home data from the whole country. Those deaths were added to the state’s overall death toll, but weren’t originally tied to nursing home outbreaks. As of February 15th, the state reports more than 15,000 deaths in nursing homes, assisted living facilities, and adult care centers since the start of the pandemic, including 5,744 deaths that occurred at hospitals.

In September, the Empire Center For Public Policy sued the Governor for the nursing home data, which he finally released last week after a court order. Bill Hammond, an Empire Center senior fellow for health policy, said the death toll is only a fragment of what experts and the public need for a full accounting of what went wrong last spring.

“The FOIL results were a step in the right direction but a pretty small step actually,” Hammond said. “To the extent that we have to have a big fight to get very basic data about one aspect of this. It’s really discouraging.”

Hammond repeated an earlier call for an independent commission to investigate what happened in order to prepare for future outbreaks, comparing the situation to what occurs after a plane crash.

“It shouldn’t be about the Governor. It should be about the plane crash,’ Hammond said. “The point of the investigation shouldn't necessarily be about pinning the blame. It should be about understanding what went wrong… There may have been some pilot error, but there probably were a lot of other issues, too.”

Hammond cited long-standing conditions in nursing homes that likely worsened outcomes once the pandemic hit, such as understaffing.

New York State officials have repeatedly pointed to statistics that the state ranks 34th out of 50 states for nursing home deaths as a percentage of total fatalities statewide, a point that Governor Cuomo reiterated on Monday. But Chidambaram from the Kaiser Family Foundation explained that this claim is a bit of a red herring. New York was hit so much harder during the start of the pandemic that its total death toll is much higher than most states, so this nursing home percentage would naturally seem lower.

“There was such a high number of deaths outside of nursing homes,” she said. “It’s very difficult to compare what happened state to state.”

New York officials are still not volunteering the volume of COVID-19 infections in nursing homes and only report COVID-19 deaths. This policy makes it difficult for families to find information about recent outbreaks at nursing homes. The state does send tallies of outbreaks in nursing homes to the federal government, which compiles a nationwide database.

Despite mounting criticism from both parties and a renewed push to revoke Cuomo’s expanded emergency powers, the Governor hasn’t wavered in his defense of how his office oversaw nursing homes during the pandemic. On Wednesday, he said he would welcome legislative hearings over his actions, even as a fiery dispute with an Assemblymember spilled into public view.

Oversight is fine,” Cuomo said.